<form enctype='multipart/form-data' action='process.php' method='post'>
<table border="1" cellspacing="1" style="border-collapse: collapse" bordercolor="#000066" width="95%" cellpadding="5">
<tr>
<td colspan="3" bgcolor="#B5CBEF" height="17" width="100%" bordercolor="#FFFFFF" background="tile_back.gif">
<p align="left\><b><font face="Verdana" size="2" color="#FFFFFF"><img border="0" src="nav_m.gif" width="8" height="8">
<font face='Verdana' size=2 color='#FFFFFF'><b>
<!- You can add a form title here -->
&nbsp;
</font><font face="Verdana" size="2" color="#000066"> </font></b></td>
</tr><tr><td colspan="3" bgcolor="#B5CBEF" height="16" width="100%" bordercolor="#FFFFFF" background="tile_sub.gif"><font size="2" face="Verdana"><b><font face="Verdana" size="2" color="#000066">
<!- You can add a brief form description here-->
&nbsp;
</font></b></font></td></tr><tr><td colspan="3" bgcolor="#D6DFEF" height="16" width="100%" bordercolor="#FFFFFF"><font size="1" face="Verdana">Please fill in all fields marked with a *</font></td></tr><tr><td height="30" width="55" bgcolor="#EFF3F7" bordercolor="#FFFFFF">
<img border="0" src="bc_new.gif" width="28" height="28"></td><td height="30" width="189" bgcolor="#EFF3F7" bordercolor="#FFFFFF">
<font face="Verdana" size="2">dfg</td>
<td height="30" width="469" bgcolor="#EFF3F7" bordercolor="#FFFFFF">
<font face="Verdana"><input type=text name='dfg'></td></tr><tr><td height="30" width="55" bgcolor="#EFF3F7" bordercolor="#FFFFFF">
<img border="0" src="bc_new.gif" width="28" height="28"></td><td height="30" width="189" bgcolor="#EFF3F7" bordercolor="#FFFFFF">
<font face="Verdana" size="2">ng</td>
<td height="30" width="469" bgcolor="#EFF3F7" bordercolor="#FFFFFF">
<font face="Verdana"><input type=text name='ng'></td></tr><tr><td height="30" width="55" bgcolor="#EFF3F7" bordercolor="#FFFFFF">
<img border="0" src="bc_new.gif" width="28" height="28"></td><td height="30" width="189" bgcolor="#EFF3F7" bordercolor="#FFFFFF">
<font face="Verdana" size="2">dsfg</td>
<td height="30" width="469" bgcolor="#EFF3F7" bordercolor="#FFFFFF">
<font face="Verdana"><select name='dsfg'><option value='dsf'>dsf</select></td></tr><tr><td colspan="3" bgcolor="#B5CBEF" height="25" width="737" background="tile_sub.gif"><p align="center"><font face="Verdana" size="2"><input type=submit value='Submit Form'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <input type=reset value='Reset Form'></font></td></tr>
</table></form> <br><br><a href='http://phpformgen.sourceforge.net'><img src='button.jpg' border=0></a>